Provider Demographics
NPI:1285418681
Name:CORNERSTONE WELLNESS CENTER PC
Entity type:Organization
Organization Name:CORNERSTONE WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JOSEPH LIMA
Authorized Official - Last Name:BOTELHO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-951-9802
Mailing Address - Street 1:88 FAUNCE CORNER MALL RD UNIT 230
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1295
Mailing Address - Country:US
Mailing Address - Phone:508-951-9802
Mailing Address - Fax:508-300-0302
Practice Address - Street 1:88 FAUNCE CORNER MALL RD UNIT 230
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1295
Practice Address - Country:US
Practice Address - Phone:508-951-9802
Practice Address - Fax:508-300-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty